Coronal restoration in root-filled and non root-filled teeth : studies on periapical status, tooth survival, subsequent treatments and treatment decisions

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Coronal restoration in root-filled and non root-filled teeth : studies on periapical status, tooth survival, subsequent treatments and treatment decisions


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Publication Doctoral Thesis
Doctoral Thesis, comprehensive summary
Title Coronal restoration in root-filled and non root-filled teeth : studies on periapical status, tooth survival, subsequent treatments and treatment decisions
Author Dawson, Victoria
Date 2019
English abstract
The overall aim of this thesis was to study the following aspects of direct and indirect coronal restoration, primarily of root-filled teeth, with special reference to: • periapical health • the natural course of root-filled teeth, particularly further clinical intervention • the dentist´s decision-making process for root-filled teeth. The aims of coronal restoration are to restore the function and aesthetics of the tooth, with a tight marginal seal as protection from microbial leakage. A coronal restoration may be either direct, i.e. a direct chairside composite or amalgam filling, or indirect, whereby the restoration, ceramic or a combination of metal and ceramic, is fabricated in a laboratory and then permanently cemented. For the root-filled tooth, a coronal restoration of adequate quality is an important factor for a successful outcome of the endodontic treatment, in terms of periapical status. While indirect restoration is often advocated as the treatment of choice for a root-filled tooth, the procedure is nevertheless more timeconsuming and 3 – 4 times more expensive than a direct restoration. In Sweden, composite is the predominant material for direct restoration and the majority of root-filled teeth are directly restored. However, some reports suggest an association between composite restoration and an increased risk of periapical disease. In terms of tooth survival, there are also reports of less favorable endodontic treatment outcomes for teeth with direct restorations than for those with indirect restorations. In Studies I and II clinical and radiographic examinations were undertaken in a random sample of 440 subjects, living in the county of Skåne, Sweden. No association was disclosed between apical periodontitis (AP) and direct composite restorations. In non root-filled teeth, a relationship was found between the type of restoration and AP. Those restored with direct restoration by both composite and amalgam combined, and indirect restoration were associated with increased risk of AP, indicating that the extent of tooth substance removal rather than the type or material of the restoration, was an important factor of influence on periapical status. For root-filled teeth, however, the quality of the restoration and of the root-filling was more important to periapical health than the type or material used for the coronal restoration. In Study III, data from the Swedish Social Insurance Agency on dental treatments were analyzed. Only minor differences in the frequency of additional endodontic treatment for root-filled teeth restored with direct versus indirect restoration was disclosed. The indirectly restored teeth also had a more favorable natural course during the 5-year follow-up period. In comparison, teeth restored with direct restorations required further clinical intervention (nonsurgical retreatment, extraction and additional restorations) significantly more frequently. In Study IV, in-depth semi-structured interviews were conducted with general dental practitioners. Data from 14 interviews were analyzed by Qualitative Content Analysis. Study IV revealed that dentists´ decisionmaking process underlying the choice of coronal restoration for a rootfilled tooth, was based not only on clinical factors; contextual factors and patient´s views, if in conflict, were decisive. Thus, despite the indications for an indirect restoration, a direct restoration was occasionally chosen. Accordingly, the context in which the dentist makes decisions may be a factor influencing the fate of the root-filled tooth. It is concluded that concerns that composite restoration poses a risk for periapical disease are not supported clinically, i.e. the use of composite seems to be safe. While in non root-filled teeth, AP tended to be associated with extensive restorations, in root-filled teeth the type of restoration was not an important factor of periapical health. For teeth directly restored after root canal treatment, further clinical interventions may be expected, especially for restorative failures. This may be attributable in part to the dentist´s decision-making process with respect to the choice of coronal restoration.
DOI (link to publisher's fulltext.)
Publisher Malmö University, Faculty of Odontology
Series/Issue Doctoral dissertation in odontology;
ISBN 9789178770441
Language eng (iso)
Subject Endodontics
Coronal restoration
Indirect restoration
Direct restoration
Root canal treatment
Decision process
Apical periodontitis
Qualitative Content Analysis
Research Subject Categories::ODONTOLOGY
Included papers
  1. I. Dawson V, Petersson K, Wolf E, Åkerman S. Periapical status of non-root-filled teeth with resin composite, amalgam, or full crown restorations: a cross-sectional study of a Swedish adult population. J Endod 2014; 40: 1303-1308.

  2. II. Dawson VS, Petersson K, Wolf E, Åkerman S. Periapical Status of Root-filled Teeth Restored with Composite, Amalgam, or Full Crown Restorations: A Cross-sectional Study of a Swedish Adult Population. J Endod 2016; 42: 1326-1333.

  3. III. Dawson VS, Isberg PE, Kvist T, EndoReCo, Fransson H. Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations. J Endod 2017; 43: 1428-1432.

  4. IV. Dawson VS, Fransson H, Wolf E. Coronal restoration of the root-filled tooth – a qualitative analysis of the dentist´s decision-making process. To be submitted.

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